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An important aspect of the opioid epidemic is the lack of treatment options for millions of Americans living in rural communities. We can expand access by engaging primary care practices—the places where most rural Americans receive care. Doctors and nurses in these practices are trusted members of the community. They need information and tools to provide effective, evidence-based care for patients with opioid addictions. Medication-Assisted Treatment, or MAT, is evidence-based therapy for assisting people with opioid addiction in primary care offices. MAT involves using both medications and behavioral support to empower people to manage their addiction. The trouble is that many primary care physicians find it difficult to introduce MAT into their practice.

The Agency for Healthcare Research and Quality (AHRQ) is investing in a series of grants to discover how we can best support primary care practices and rural communities in delivering MAT through a series of grants that will be awarded soon. AHRQ is investing approximately $12 million over 3 years in this initiative, which was announced on July 15, 2016.

For those who don’t know, this is what AHRQ does—invest in research to address pressing problems in health care delivery and develop the tools and training to ensure that health care systems and professionals understand the evidence and can use it to improve health and health care. This initiative will bring together innovative teams of State health departments, academic health centers, researchers, local community organizations, physicians, nurses, and patients to bring MAT to hundreds of rural practices in places such as Muskogee County, Oklahoma, where there were more than 10 opioid-related deaths per 100,00 people per year over the past few years, where over 1300 people are thought to be in need of treatment for opioid addiction, and there are currently no primary care physicians providing MAT. And Bent, Colorado, where the rate of overdose death rate has increased from fewer than 10 to over 20 per 100,000 since 2002.

The practices involved in the initiative will provide access to MAT to over 20,000 individuals struggling with opioid addiction using innovative technology, including patient-controlled smart phone apps, and remote training and expert consultation using Project ECHO. Project ECHO is a tele-health program started with AHRQ support that links specialists at an academic hub to primary care providers working on the frontlines in rural communities. Together with their grantees, AHRQ will build a blueprint for how other communities and primary care teams can overcome the barriers of providing MAT and ensure access to care across America’s rural communities.

The four awards are:

The American Institutes of Research in partnership with the State of Oklahoma, Project ECHO from New Mexico, and expert consultants from the American Society for Addiction Medicine. Rural Oklahoma includes some of the communities most affected by the opioid epidemic. Led by Dr. Susan Heil, this project will build on efforts already underway in Oklahoma to address opioid abuse, including the development of pain treatment guidelines, public awareness campaigns, initiatives to support the distribution of a medication called naloxone (which blocks the high from opioid abuse), and the creation of community-based comprehensive community addiction recovery centers. Currently, however, the vast majority of treatment services for people with opioid addiction in Oklahoma are in urban areas. This project will expand access to thousands of people living in 28 rural counties in the northeast, north central, and south central parts of the State. The project will engage hundreds of physicians, providing customized and ongoing training for physicians and members of their teams to support them in providing MAT to their patients. Based on their experience and a robust evaluation, the team will produce training materials to assist other rural communities and primary care practices across the country to expand access to MAT.

The University of Colorado, Denver. Under the leadership of Dr. Jack Westfall, a family physician who recently was certified to provide MAT, this project will expand access to MAT across 24 counties in eastern and southern Colorado. Using a multi-pronged approach, the team will begin by partnering with community members to co-create messages and materials that are locally relevant and that deepen community awareness of opioid use disorder and knowledge of MAT. The team will provide primary care practices with comprehensive training and support for delivery of MAT in their rural primary care practices using face-to-face practice coaching and an ECHO tele-training model. This project will also include a comprehensive evaluation and the development of resources to allow other States and primary care practices to expand access to MAT.

The Pennsylvania State Department of Human Services in partnership with the Pennsylvania Office of Mental Health and Substance Abuse Services and the University of Pittsburgh. Led by Dr. Dale Adair, the ambitious goal of the project is to double the number of primary care physicians delivering high-quality MAT in 23 rural Pennsylvania counties. The initiative, which has a special focus on people covered by Medicaid, will link primary care practices with community-based substance-use disorder health homes. The grant will blend onsite practice support with online physician MAT training with ongoing expert teleconsultation and expanded access to tele-psychiatry services to people with opioid abuse disorders living in rural communities. Like the other grants in this initiative, it has a multi-faceted evaluation plan and a comprehensive plan to disseminate findings to State and national stakeholders.

The University of North Carolina at Chapel Hill. Under the leadership of Sherri L. Green, Ph.D., the core aims for the UNC Extension for Community Healthcare Outcomes for Rural and Primary Care Medication-Assisted Treatment (UNC ECHO for MAT) demonstration project are to broaden understanding of and evaluate strategies for overcoming barriers to implementing MAT in primary care, while expanding access to MAT in 22 counties through a multi-layered provider and practice engagement approach to reduce the risk of accidental overdose deaths. The program will use a Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) approach and telehealth strategies to gather and evaluate participation and quality data. Effectiveness of the intervention will be assessed indirectly, using Medicaid and insurance claims data.